Broad bipartisan support for Medicaid expansion

Broad bipartisan support for Medicaid expansion

In 2016, Gov. John Bel Edwards expanded Medicaid eligibility for working poor families in Louisiana, a choice that has saved lives in our state. As a result of Medicaid expansion, nearly 300,000 people in our state have started seeing a doctor, 37,000 people have been screened for colon cancer, nearly 12,000 of whom have had colon polyps removed, averting colon cancer, and 66,800 women have been screened for breast cancer. And while the program has been something of a punching bag in the House Appropriations Committee this week, a new poll from LSU’s Reilly Center for Media & Public Affairs shows that the general public supports the move to broaden access to health care for people earning less than 138 percent of the federal poverty level—even across party lines:

Louisiana expanded its Medicaid program in 2016 under the auspices of the federal Affordable Care Act. For the third straight year, the Louisiana Survey shows that a large majority of state residents approve of this move. Today, 76 percent of Louisiana residents approve of Medicaid expansion. This percentage of approval has remained steady since expansion. Approval of Medicaid expansion is bipartisan. Although Democrats express the highest levels of approval, majorities of Republicans (57 percent) and independents (73 percent) also express favorable opinions of the policy. Of particular interest, Republican approval for Medicaid expansion has grown in the years since the state implemented the change.

The poll also reveals that the state has room to grow in making sure that people who might be newly eligible for insurance coverage under expansion are aware of the program.

Knowledge of Medicaid expansion is particularly low among low-income households. Although the demographic data collected in the survey does not allow us to identify which participants are eligible for Medicaid coverage, it is likely that more individuals whose household incomes are below $25,000 (roughly the bottom 30 percent of Louisiana households) are eligible for Medicaid than individuals whose household incomes are greater because it is a means-tested program. Yet, this is the income group with the lowest level of awareness of Medicaid expansion.


Budget negotiations back on track
After a five-month deadlock caused by House Speaker Taylor Barras, the Revenue Estimating Conference finally recognized $229 million in additional general fund dollars for the state to spend in the next 15 months. As The Advocate’s Sam Karlin reports, this clears the way for legislators to fund the programs and services that Louisiana residents rely on every day.

(Gov. John Bel) Edwards said he plans to protect the increased funding in higher education, as well as the popular TOPS tuition program, as the budget works its way through the Capitol. The Taylor Opportunity Program for Students program has a slightly larger gap in funding, $12.3 million, than originally anticipated, something the governor said he is working to fill.  A raise for school teachers appears likely to survive the process. The governor and lawmakers from both parties have backed it, and (Rep. Cameron) Henry included it in his budget proposal even before the Revenue Estimating Conference recognized new money.

The Advocate’s Editorial Board did not hold back in their assessment of a delay that reeked of political posturing and that was untethered from both good governance and economic reality:

This was politics, not economics. In an election year, the speaker clearly abused his role by throwing a wrench into the budget process. Perhaps the speaker’s tactic started as a below-the-radar event, but it prompted a line of procedural dominoes to fall, with the new legislative session having begun without an agreed-upon budget number. That meant that the budget bills, from the governor and from his Republican opposition in Barras’ House, were unmoored by any consensus estimate of revenues. This made a mockery of what the REC was created to do. It was born of a reform decades ago intended to prevent the budget from being inflated by politicians for their own purposes. The revenue estimates were not wrong. Barras should have approved them. What this little fracas showed is that there is an intellectual deficit in Barras’ caucus.


Who really gets paid by harmful public benefits “work requirements”
Robust research shows that taking food and health coverage away from underemployed and unemployed people does little to nothing to help them find new or better work. Since public benefits programs often function as work supports, harsh time limits may result in lower employment and higher poverty rates. Now, as the Trump administration considers a change to SNAP rules that could imperil food assistance for 755,000 underemployed Americans—including 50,000-70,000 Louisianans—a new report by H. Claire Brown at The New Food Economy reveals how Wisconsin’s mandatory work program for SNAP recipients has harmed those it was supposed to help, while lining the pockets of the contractor paid to implement it:

Deatre McNeal, a 31-year-old single mother from Milwaukee, entered ResCare’s employment training program voluntarily in 2017. She was not subject to the state’s work requirements at the time because she was the parent of a minor, though under Wisconsin’s new rules her enrollment would have been mandatory. McNeal was working part-time at a Golden Corral restaurant and hoped that joining [the FoodShare Employment Training Program] would help her qualify for a better job. She wanted to take classes that would certify her as a caregiver for homebound adults. Once certified, she would be able to administer medicine and could apply for full-time positions that pay upwards of $9 an hour.  The caregiver training could have been completed in a week. But a year later, McNeal was no closer to her goal. She says she was assigned to a different case worker every month, and at one point she was asked to restart the whole training process. “It was always something,” she says. McNeal eventually found help elsewhere. In December of 2018, she enrolled in a private training program where she quickly obtained the certification she needed, and found work as a caregiver immediately. In the meantime, however, she’d fallen behind on rent payments. McNeal was evicted from her apartment the day after she was granted her caregiver license. Even though she found new work, her paycheck didn’t arrive in time to pay rent. She and her daughter moved in with her brother. Looking back on her year with ResCare, McNeal calls it a “waste of time.” What should’ve been an opportunity for career advancement instead left her without a permanent address. A program she’d entered voluntarily—but which is mandatory for an ever-widening swath of the population—failed her every step of the way.


Ducking the bill for investments in an educated society
As state budgets withered after the Great Recession, state governments shifted the cost of public higher education from society at large to students and their families. A decade later a few states have reinvested in higher education, but the majority have left cuts in place and students footing the bill, even as the economy has rebounded. Inside Higher Ed’s Greg Toppo reports on a new study detailing how tuition remains the main driver of higher ed funding, disadvantaging low-income and non-traditional students. Louisiana, not surprisingly, is near the bottom of the pack.

The phenomenon also undercuts efforts to make college more affordable and accessible, said Kim Hunter Reed, Louisiana’s commissioner of higher education. “At a time that we have said that it [higher education] is a necessity, not a luxury, we are pricing education as a luxury.” … In Louisiana, which had one of the largest declines in funding since the recession, Reed, the state higher ed commissioner, said several years of “stable funding” haven’t made up for “one of the worst disinvestments in the nation” during the recession. “We’re concerned that we’re working against our goal of making sure that education is as affordable and equitable and accessible for all of our students,” she said. Reed, who on Monday was preparing to begin the state’s new legislative session, said Laderman’s fears about the next recession are real to Louisiana families. “We can’t price ourselves out” of consideration for most families, she said. “We feel like we are at that point already.”


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Number of the Day
39.7 percent – Reduction in Louisiana state funds appropriated for higher education since before the recession. Louisiana has instituted the second highest reduction in state higher ed funding of any state over that period, behind only Arizona. (Source: State Higher Education Executive Officers Association, via Inside Higher Ed)